My name is ashish. My mother was admitted for knee replacement surgery on twenty third June for each the limbs below single package that stands at five lacs. My mummy is insured by a mediclaim policy by star health and allied that started in mar, 2017. She was later diagnosed with ild in jul, 2017.

Before admitting, i got initial consultation from dr. Ajit gohel at shalby. throughout the this consultation, i might shown all the medication that my mother accustomed be taking – one amongst them is for ild by dr harjit dumra of sparsh.

Somehow, the doctor didn’t provide importance to the ild or the other treatment that was current. He was simply centered on knee replacement (As that’s their primary goal to fulfill the numbers i suppose!!)

Basis the initial consultation and x-ray reports of knees, we have a tendency to got the initial approval of two.5 animal product that is five0% of the overall add insured (5 lac) from star health and allied.

Now, throughout the preoperatives, that happens on the primary day after you get admitted, the specialist checked out the ild treatment papers and in the future later he asked Pine Tree State to place that paper into the shalby file. And, so i did.

Now, star health and allied medial officer took a glance at this ild paper. They rejected my claim on the grounds of non-disclosure of ild. Right now, i’m having to administrated entire surgery add that stands at five animal product. i’m not mentally also as financially able to pay such giant add of cash. I’ve already paid 3lac and issued a post dated check of 60k that is due in four days.

I have the subsequent questions:

1) why initial consultation paper didn’t have any mention of ild if it’s necessary for the surgery. Had ild been mentioned within the initial paper, i’d not have gotten pre-authorization of two.5 animal product and then i’d have gone for economy package at avatar shalby or elsewhere for cheaper treatment that i will afford.

2) if initial consultation very didn’t need it as a result of ild isn’t connected for this kind of surgery, then why it absolutely was place in a while in shalby file inflicting this whole issue and distress and burden on Pine Tree State.

3) since ild was diagnosed when the commencement of the policy, i need to fight for my rights with star health and allied insurance. But, hospital isn’t able to provide Pine Tree State the treatment file and then, i’m being denied of my rights. Hospital individuals say that unless i pay the complete quantity, the file won’t be handed  over to Pine Tree State. that is harrassment. after I took discharge on Saturday, 29th june, i used to be given assurance by man. Ravi Prajapati that i will be given the file provided i pay 3lac and issue a check of sixty, 000/ post dated. I already paid three lacs and my sixty, 000/- check is thanks to be cached on ninth jul. Even when being given the assurances, hospital has currently turned back from their words. I’ve visited the places a minimum of three times and each time i met completely different individuals as asked. But, constant answer. does one guys have some single authority WHO will handle the matter. It’s all those with none authority individuals area unit handling the matter. 

4) why at the time of discharge, man ravi didn’t ask authority and approved. He simply faked it as he wished the area to be vacant, it seems.

5) I actually have no grudges with regards to the treatment or the workers. They were glorious. It’s simply that you just cannot handle dispute resolution. Plus, the docotors WHO offer initial consulting don’t appear to be trained enough for the ramifications of their consuting papers. individuals like North American country area unit having in contact the force of their incompetence. this can be not acceptable.

6) why cannot the initial consultation be rock-solid to avoid such surprises in a while that area unit distressing for patients and their family? 

I was foiled with shalby, being such a large name, they are doing not appear to possess any processes – to resolve disputes or for initial consultation. however on earth a layperson would suppose that he wouldn’t get something when pre-authorization of two.5 lac.

I really anticipate to cooperation by hospital thus i will fight for my rights with the underwriter.

Thanks-

Ashish